How to evaluate candidates with chronic health issues

How to evaluate candidates with chronic health issues

By Myles N. Sheehan S.J., M.D.

Evaluating a candidate’s suitability for religious life in a particular congregation can require considerable reflection and evaluation. This is especially true when the candidate has a chronic health condition. What are some guidelines to assist vocation directors and other decision-makers considering such a candidate? As both a physician and a Jesuit priest, I can provide some suggestions and rules of thumb. But these suggestions depend much on the candidate, the exact details of the chronic illness evaluated in a holistic perspective, and the charism and resources of the congregation. I suggest three questions to provide a framework for considering the suitability of a candidate with a chronic physical health condition:

  • What is the impact of the condition?
  • What is the assessment of health care professionals?
  • Does the candidate make sense for your community?

Assessing the impact of the health issue

I’ll begin with the first question regarding the effect of a particular illness or diagnosis upon the candidate. This question has several facets, beginning with a diagnosis. Many individuals carry around a diagnosis of an illness, but they are doing well. It is important that vocation directors not reject simply on the basis of the candidate’s report of a diagnosis. That report should be the start of a conversation. As an example, a candidate may have been told that she has rheumatoid arthritis. This disease can vary from debilitating and life threatening to a relatively easily-controlled condition that rarely flares up. It would not be sensible to admit into religious life someone who is seriously ill with a poor prognosis. But another individual could have the same diagnosis and live without any real problems. You can avoid arbitrary decisions by recognizing that a diagnosis may not tell you much and that you need to dig a bit deeper.

Second, individuals with a chronic illness may have limitations in function. Specific understanding of how the illness affects the individual’s functional abilities is crucial in determining the suitability, or difficulty, of a person’s entry into a religious community. Is the person able to take care of the most basic activities of daily living? Can he or she get in and out of bed without assistance, shower or bathe, use the toilet, get dressed, take care of basic personal grooming, and feed himself or herself? A deficit in one of these six activities of daily living is a sign that a person cannot live independently and needs either a home health aide or care in an institutional setting.

There are other tasks crucial for independent functioning. These are called instrumental activities of daily living. There is no simple list for instrumental activities. These are the tasks that allow us to interact and be independent in the larger community. They include managing one’s checkbook and financial resources, using transportation, shopping for household supplies and groceries, keeping an apartment clean, preparing food, doing laundry and the like. Many individuals (particularly some men who are otherwise without a diagnosis of chronic illness!) might have an isolated deficit—some people don’t cook; others don’t drive; some people are sloppy about cleaning. But when a person has multiple deficits, it requires a lot of effort to keep that individual safe and otherwise healthy. When a person with chronic illness is losing the ability to perform these activities of daily living, it is a sign that the illness is progressing and taking a larger toll. Deficits in activities of daily living or a progressive loss of ability to perform the instrumental activities of daily living indicate an individual needs substantial assistance.

Attitude and approach to the illness

It is also crucial to evaluate the impact of the illness on the person and those around that person. This involves thinking about how the illness influences the person psychologically, in social interactions and in community. It requires consideration of how the illness is part of the person’s spiritual life. Some people with what appear to be minor health conditions can be completely absorbed in the illness, be wrapped up in visiting a variety of physicians and other caregivers and be a general pain in the neck to be around. The illness is the focus of the person’s life, monopolizing conversation and creating a situation that limits the freedom of the individual to pray and work. When illness is the focus, it also creates difficulties for those who live with him or her.

Conversely some individuals with serious health conditions—for example, a complicated case of diabetes—are exemplary in taking prudent control of their illness, occasionally need a hand when there is a problem (an episode of low or high blood sugar), and deal well and courageously with the possibility of more serious problems down the road (people with diabetes are at higher risk for vascular, vision, and kidney problems than those without). This type of person may well need to make regular visits to the physician. He or she sometimes gets anxious about a problem related to the diabetes and recognizes that his or her prayer may often refer to hopes and fears related to the illness. These features would suggest a realistic integration of a problem.

But candidates who seem overly involved and identified with their illness, whose lives and personality are filled with excessive drama and conflict, are likely not going to be happy in religious life and may well make life miserable for those with whom they live. Vocation directors would do well to exercise caution with the candidate who appears to have a variety of caregivers seen with great frequency and with multiple emergencies, who continually feels poorly, and whose conversation, energy, and probably prayer all revolve around his or her condition. Religious life always involves giving something up; it may well be that giving up being sick is too much for some individuals. If the person’s identity revolves around a medical diagnosis, either because of the person’s personality or the severity of the illness, then it will be difficult for that person to be integrated into religious life.

Finally, in seeking to understand the impact of a health condition on a candidate, I suggest that the vocation director look at some basic facts. How old is the individual? An older person with a chronic illness who is beginning to have increasing difficulty is not likely going to be able to do as much apostolic work as a young person who has a potentially disabling chronic illness but who is currently active, independent and doing well. How much does the illness cost the person daily in money and time? A person may have an illness or a diagnosis that requires a variety of medications that are extremely expensive and demand careful monitoring and a rigorous schedule. Again, this type of regimen could be tough when the focus is supposed to be on apostolic life. What is the prognosis of the illness? There are a lot of reasons why people may consider religious life. Having a life-threatening illness often makes people want to square things away with God and, for some, that might mean making a dramatic move into religious life. I would not question that God may well be working with a person who has a fatal illness who seeks religious life. I would be very cautious and likely fairly skeptical that God is calling that person to religious life. Instead I would work with that person to assist in discerning God’s call in such an emotionally charged time.

Listening to health professionals

The second main question for a candidate with a chronic health issue is: what is the assessment of health care professionals? The vocation director can only do a certain amount of assessment personally. In eliciting assessment of a candidate, there are three points to consider.

First make sure you have a physician that you or your congregation trusts to make an initial assessment and determine what further assessment may be needed medically. I would not rely on the evaluation of the candidate’s physician as the only assessment. The person’s physician likely will provide valuable insight and essential details of the medical facts of the person’s condition and history. But it is unlikely that the candidate’s physician will understand much about religious life, much less the particular details of a congregation, in order to give the advice and insight that a physician known and trusted by the congregation can give. It could be that the doctor may want to help the patient in his or her goal and may present a somewhat more optimistic picture than a less biased observer.

I suggest that a general assessment be done by an internist or family practitioner who is known to the vocation director and who has a realistic sense of the congregation. That general evaluation may well require follow-up and a visit to a specialist in order to provide a fuller picture. Determining a prognosis for a person who is currently stable, particularly one that in volves a disability, is not always straightforward for a primary care physician. Evaluation by an expert in rehabilitation medicine (also known as a physiatrist) may help determine the possibility of increasing disability, whether the person might need adaptive equipment, and what type of work the person could sustain. Other individuals could require assessment by specialists in arthritis (rheumatologist) or neurology. For a candidate who seems promising, that type of careful evaluation is crucial in making sure there is true freedom on both sides before committing to a formation program.

In proceeding with this type of assessment, the vocation director must be very clear with the candidate about the sharing of medical information. If the religious order arranges for an assessment, the results of that assessment need to be shared with the vocation director and others who would decide about admission to the novitiate. The candidate will need to sign a release with the physician doing the evaluation to allow him or her to share information about the visit with the vocation director and the director’s colleagues. Generally it is not appropriate for the vocation director to share this type of personal health information with the community. But the candidate needs to understand that confidential details about one’s health history must be shared with those in a congregation who decide on admissions.

Second it is important that skilled psychological assessment be performed as part of the determination of suitability for religious life. This is increasingly true for any candidate. It is even more important for individuals with chronic health issues, not because they are more likely to be mentally ill, but because it is essential that the community know about coping styles, areas of vulnerability, and response to stress and adversity. An individual who is physically robust but psychologically unstable does not make a good candidate for religious life. This is true, a fortiori, if the person has serious physical health problems.

The third point to think about is the physical environment of the formation community in which the candidate would live. If you are going to accept a bright, gifted, and mature young man who is wheelchair-bound into your community, you better be sure, at a minimum, that the novitiate is wheelchair accessible, that he will have a bed that allows him to pull himself up and out in the morning, that there is an adequate toilet and shower facility, and, in the event of a fire or some other emergency, there is a reasonable escape route. How do you get such an assessment? It depends on the resources in your area. As a start you could contact a local rehabilitation hospital and ask for a referral for a home assessment. A therapist skilled in matching the needs of an individual to the home environment can help provide advice.

Does the candidate make sense for your community?

All of these considerations lead to the third main question of this article: what type of candidate makes sense for your community? This depends on your order’s charism, the expression of that charism in its rule or constitutions, the reality of the community’s resources (personal, financial and physical) and the presence of other gifts in the candidate that could make accepting an individual with some problems a worthwhile decision. The issue here is not so much the possibility for ministry for the candidate, but how will the candidate affect the congregation’s ministries?

Careful attention to charism and the congregation’s own tradition is essential. In my religious order, the Society of Jesus, our charism emphasizes active work in the world. Our constitutions are very clear. Candidates are only to be accepted if they are capable of engaging in active, apostolic work. Thankfully for the church, there are many charisms alongside that of the Society of Jesus that allow a multiplicity of gifts for the church and the people of God. Vocation directors and their colleagues should look carefully at the spiritual resources of the community, the plan of the founder and the expression of that plan. It could well be that an outstanding candidate for one religious order would not be considered by another. Be cautious in making too many allowances for a candidate’s physical condition if your charism emphasizes activity, independence and vigorous apostolic commitment. It seems unlikely God would call a person who is dis abled by chronic health concerns to a group God has called to an active life in the world.

Chronic illness always has implications for ministry. Those implications can be for the person with the illness and for those in the community who need to care for that person. For example it may be that a candidate has an excellent contemplative potential, but caring for that person might limit the work of contemplation for the community. Vocation directors need to be cautious in accepting a person with a chronic progressive illness because of the impact this could have on other community members. It may well be that a candidate has a number of outstanding features, but other issues would divert the community from its principal obligations. Taking a chance on a candidate and risking damage to the work done by a congregation does not make sense.

Resources matter

Resources are another important consideration. This area is not just practical but has to do with the current reality of your congregation, the “signs of the times.” Simply stated, if a congregation is dwindling, aging, and increasingly strapped for resources, then vocation directors need to be careful about accepting a new burden for the community. Likewise if a person requires expensive medications and therapies, then one needs to see if this expense is going to make life hard for older, frail members of the community to whom the community, in justice, already has a commitment. Thinking about the future is also part of the vocation director’s resource assessment. This means not only considering the prognosis of the candidate, but the prognosis for the community’s ability to care for and assist members who need help. Currently many large institutional communities provide significant help in the instrumental activities of daily living. In these communities meals are prepared, food is served, there is no need to shop for groceries, bills are paid by individuals in the treasurer’s or superior’s office, and individual religious are supported completely by the community structures. Communities like these frequently have members with chronic health issues. It’s easy to imagine a new member with talents and some health issues fitting into the rhythm of such a community. The problem for active religious orders is that communities like these are not likely to be around for long because of dwindling vocations. Large monastic communities set up like this will likely persist in a few settings, but declining vocations could also make accepting a new individual with health problems an unfair burden on the community. Vocation directors need to think about who will be around to help in the future and the type of community where people will live in the future.

 

CASE STUDY: SETTING A HEALTH POLICY FOR A MISSIONARY ORDER

The challenge of meeting health care needs of members of religious congregations can be formidable. For a congregation, such as my own, whose charism is transcultural missionary work, the challenge is that much greater.

Our active members must seek medical care from reliable providers in the countries where they are living and working or in a neighboring country. Some countries do allow expatriates to participate in the nation’s health care program. Others make the premium for foreigners so high, it isn’t cost effective to participate. Still other times, a missionary engaged in a ministry of “service” is able to obtain a discount for medical care. We do find that the cost of exams and treatment is, almost without exception, much less than what we would pay here in the U.S. However, often there is a problem in finding quality care, especially in underdeveloped countries where many of our members minister to the poor and marginalized.

All this points to the need for congregations whose primary focus is overseas transcultural work to be especially concerned about the health status of those applying for membership. It may well be appropriate for religious communities whose members live and work in the U.S. to accept applicants with problems such as diabetes, chronic cardiac disease, deafness or blindness. But if it is expected that the members will live and minister in areas where even primary medical care is essentially lacking, it would be a disservice to the individual and the group to encourage people with these problems to seek admission. Thus the Maryknoll Sisters expect applicants to meet a high standard of good health for admission.

by Dolores Congdon, MM, of the Maryknoll Sisters of St. Dominic, who is administrator of outpatient care at the Maryknoll Sisters Center, Maryknoll, NY

 

 

Some of the issues regarding resources need to be tried out for a community to understand the reality of what it would mean to accept a member with a chronic health issue. This would especially be the case with a person with a chronic disability. Trial periods in the community are valuable for any type of candidate. But in the case of candidates with a chronic illness, they can be even more crucial. The candidate can see if there are accommodations a community is willing to make to provide for his or her independence. The community can see if the candidate is serious about the ministry and fits in well, or if he or she is overly focused on personal issues, no matter how understandable that focus may be. Likewise, both candidate and community may come to understand that a truly wonderful individual may not be called to a particular community because of a lack of resources to provide needed assistance for the candidate and the potential for limiting the ministerial freedom of members of the community. It may also be the case that trial living periods lead to good challenges on both sides. Community members can learn to move a bit out of their accustomed routines and recognize that God is calling them to make some accommodations for a wonderful new member. And the candidate can realize that he or she faces a process of give and take in discerning God’s call and in integrating into the community.

Vocation ministers are called upon to exercise prudent judgment for every serious candidate. When a candidate has chronic health concerns, the vocation minister must gather even more information and consider a host of additional issues. I have suggested that vocation directors who are working with an individual with a chronic health problem need to consider three main issues: the impact of illness on the person, appropriate evaluation by health professionals, and the resources of the community (with resources being understood very broadly) to assist the person both now and in the future.

Perhaps some readers are disappointed that I have not provided a list of diagnoses that qualify or disqualify for religious life. However I see a variety of diagnoses among the religious I know well. I recognize that there are religious without any chronic health problems who are highly problematic for the community, as well as some with a tremendous burden of illness who contribute much apostolically and edify the community. That complex picture makes me advocate for a careful, honest, and realistic assessment on a case-by-case basis.

Myles N. Sheehan, SJ, M.D. is a priest, physician and member of the Society of Jesus, New England Province. He is senior associate dean and associate professor of medicine at Stritch School of Medicine, Loyola University of Chicago.



This article has no comments or are under review. Be the first to leave a comment.

Please Log-in to comment this article

Fall Institute ...
Orientation Program, Behavioral Assessment 1 and 2 offered this year. Register ...  More
Ordinations increase again ...
The 2017 USCCB/CARA Ordination Class Report states the number of ordinands ...  More
Sister Sharon Dillon interviewed ...
In an in-depth interview with the website Catholic Profiles, the NRVC ...  More
July newsletter ...
Our publications win awards; new vocation ambassadors are talking up religious ...  More
National Catholic Youth Conference ...
In collaboration with NFCYM, NRVC invites you to be part of ...  More
HORIZON Spring 2017 ...
Vow of poverty | Church teaching on vocation | Intercultural communities ...  More
NRVC Member Area

CONNECT WITH NRVC

July 2017

NRVC Office Closed

July 3-4

NRVC Summer Institute

July 10-25

Member Area Meetings

No NRVC Member Area Meetings in July

 

SUPPORT NRVC

Iamnrvc
Renew your NRVC membership